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Gundersen Health Plan Review

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UPDATED: Nov 30, 2018

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Wisconsin-based Gundersen Health Insurance is a part of the not-for-profit Gundersen Health System. In 2017, they joined with several other local insurers to become a part of Quartz Health Solutions, offering a variety of products and a larger local network.

About Gundersen

La Crosse, Wisconsin local physician Adolf Gundersen and his clinic are the namesake of what is now Gundersen Health, with a history stretching back 125 years. In 1902, Gundersen became medical director of the newly opened Lutheran Hospital, where he fought all the way to the Supreme Court to earn the right of hospitals to set hiring standards for their staff, ensuring higher quality medical care. That case became a national precedent that impacted hospitals across the country.

In 1995, long after Dr. Gundersen’s time, the merging of Gundersen Clinic and Lutheran Hospital formed Gundersen Lutheran Inc. Initially available only to employees, health insurance within the newly formed health system was soon made available to the general public as well. By 2013, the system was renamed Gundersen Health System, and the health plans spread into neighboring states Minnesota and Iowa.

Gundersen Health became a part of Quartz Health Solutions in 2017, along with Unity Health and Physician’s Plus, both Wisconsin insurers. The change opens up a wider network of care to Gundersen members and resulted in a re-branding to the Quartz name. Gundersen continues to exist and operate as a legal entity, but now uses the new name and logo. Plans for 2018 are Quartz branded and the website redirects to Quartz.

Gundersen offers individual and family health insurance plans as well as Medicare Advantage and group benefits. You can read our review of Gundersen’s Medicare coverage, known as Senior Preferred, here.

Gundersen Health Plans

For 2018, all Gundersen plans will be branded under Quartz, with the same plan offerings as Unity Health, which has also rebranded. The Gundersen website redirects to Quartz, which then redirects to Quartz-branded plans on the Unity Health website. 2017 plans are still sold under the Gundersen name.

This re-branding is likely to cause quite a bit of confusion, particularly with the redirection between web addresses, but hopefully, this will be cleared up in the near future. At the moment, it appears that Gundersen and Unity will offer the same plans with the same coverage under the Quartz name. These include a catastrophic plan as well as several of Bronze, Silver, and Gold plans.

For the purpose of this review, we will give an overview of these Quartz 2018 plans.

Individual Plans

There is one Catastrophic plan, featuring a $7,350 individual and $14,700 family deductible. Preventative care is available with no deductible, while all other services are subject to the deductible, after which they are covered in full.

At the Bronze level, there are five plans. Three of these are HSA plans, allowing for the use of a pre-tax savings account towards medical costs. The three plans have individual deductible options at $5,000, $6,000, and $6,550. Zero percent coinsurance is offered at the $6,000 and $6,550 deductibles, once the deductible is met. The $5,000 deductible option has 20% coinsurance after the deductible.

The remaining Bronze plans are copay based with some coinsurance as well. The first has a $6,500 individual deductible and 40% coinsurance after the deductible is met. Copays start at $25 for primary care as well as prescriptions. The second plan, the Bronze PCP Copay $35 plan has a $6,650 individual deductible. The primary care copay is $35, with a $75 copay for a specialist visit. Prescriptions start at a $35 copay.

Two of the Silver plans have an HSA option. The lower deductible, $3,000 individual, has a 30% coinsurance after the deductible is met. The higher deductible choice, at $5,050, covers everything at 100% after it is met.

There are also three Silver PCP Copay plans. The $7,100 individual deductible plan has a primary care copay of $75 and specialist copay at $150, while prescriptions start at $15. The $5,000 individual deductible option has a $35 primary care copay and a $75 specialist copay. Again, prescriptions start at $15. The lowest deductible is the $3,000 individual, with a primary care copay at $30. Specialist visits have a $65 copay. While prescription copays again start at $15, this plan has a separate pharmacy deductible of $500.

Of the Gold plans, only one has an HSA. This plan has an individual deductible of $1,800 and a 10% coinsurance after the deductible. All of the other Gold plans are copay plans. The $3,500 individual deductible plan is the highest of the deductible choices. It has copays of $30 for primary care and $60 for specialist visits. The $2,900 individual deductible plan has the same copays at $30 for primary care and $60 for specialists, and both plans have prescription coverage starting at a $10 copay for generics.

The remaining two plans both have a $20 copay for primary care, with deductible options of either $1,700 individual or $1,400 individual. The higher deductible also has a higher specialist copay at $70 versus $50, but prescriptions start at $5 versus $10.

Group Coverage

Gundersen writes small group insurance plans for employers. For 2018, these plans are only offered in Iowa and Minnesota. Like the individual plans, all group benefits are being rebranded to Quartz for 2018.

Rates

The 2018 health plans are rated the same as Unity Health’s plans through the Quartz website, which offers online quoting.

For a 30-year-old male in Dane County, Wisconsin, we returned a rate of $245.84 per month for the catastrophic plan, which is the cheapest monthly rate of all the plans. It is the only plan that came in under $300 a month. The most expensive plan is the Prime Gold Standard, at $488.65.

These rates are a little on the high side for an HMO, based on what we have seen from other Wisconsin insurers. This may reflect the increased network available as a result of the Quartz affiliation. Since we do not have previous rate information for Gundersen, we are unable to compare this quote with their prices prior to the re-branding.

Claims

It is unclear at the time of this review how the Quartz branding will affect claims processing. Gundersen is an HMO that generally processes claims directly with its chosen network of providers, most of which were within Gundersen Health up until the recent change.

The wider network offered by Quartz may slow down claims processing, particularly as things are ironed out from the change.

Ratings and Consumer Reviews

Gundersen Health System’s Better Business Bureau (BBB) rating has dropped from a B+ to a B- since we last checked for our Medicare review. While there are only seven complaints in the past three years, one has not been resolved, resulting in a lowered rating. There is no direct BBB rating for the Health Plan side of this company.

Gundersen Health Plan does not appear on any of the major consumer review sites, with just one review found on Google. This is not surprising given the fact that they are a small, regional insurer. Their new brand, Quartz, is new to the scene and doesn’t yet have much in the way of a reputation. We expect this to change over time as Quartz becomes better known, particularly since it brings several companies together under one brand.

The Bottom Line

The re-branding of Gundersen to Quartz is likely to cause some confusion for those seeking new insurance, and also likely to affect current customers. While the plan options under the new brand appear comprehensive, they are a little on the expensive side, and the changes still in progress are likely to give some insurance shoppers pause. Gundersen, however, does have a long history and a solid reputation, so those seeking a local HMO may still want to keep this company on the list.

For a list of companies that we recommend, visit our Best Insurance Companies page.

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About Eric Stauffer

Author: Eric StaufferI am a former insurance agent and banker turned consumer advocate. My priority is to help educate individuals and families about the different types of insurance they need, and assist them in finding the best place to get it.

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